HomeMy WebLinkAboutPermit Electrical 1995-08-14,OREGO'VCITY OF
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ELECTRTCAL PERHIT APPTICATTON225 FIFT'E STREET
SPRINGFIELD, OREGON
TNSPECTION REQTIEST:
OFFICE: 726-3759
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JOB
Permits are non-transfera and expire
if vork is not started vithin 1B0 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATTON ONLY
Electrical- Contractor
Address I
3. COHPIJTE TEE SCEEDTIIJ BELOII
A. Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular Dvelling
Sertice or Feeder
s 8s.00
$ is.00
$ 40.00
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps
401 amps
601 amps
Over l-000 amps/volts
Reconnect Only
c Temporary Services or Feeders
Installation, ALteration or Relocation
City Job Numbe. 95 I 3 3s
to 400 amps _to 600 amps _to 1000 amps_
Sum
d
citv €-9t"t Phone
Supervisor License Number
$ s0.00
$ 60.00
s100.00
s130.00
s300.00s 40.00
$
$
,q
s
40.00
40. 00
20.00
36.00
I
Expiration Date
Constr Contr. Number q ?yq)
Expiration Date n
Signatu Supervi trician
Ovners Name
Address
200 amps''or Less
201 amps to 400 amps
-0ver 401 to 600 amps
Over 600 amps or 1000-voTTs
40.00
55.00
80.00
ee rrBrr aEove
Ci ty Phone
OIJNER INSTALI,ATION
The installation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
DATi
Nev, Alteration or Extension Per PaneL
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. MisceLlaneous (Service/feeder not included)
D. Branch Circuits
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAI
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-Each insta]lation
Pump or irrigation _ $
Sign/Outline Lightitg- $
Limi ted Energy/Res - S
Limi ted Energy/Comm --V S Ai',a u
d5
RECETVED
AI4RI{'SISTEI{ PERI{rr - $40 FEE
CITY OF SPRINGFIELD
DEVELOPMENT SERVICES
225 FIFTH STREET
SPRING LD 9 77
DATE:
IS TIIE ALARH SYSTEM BEING INSTALLED AT A RESIDENTIAL OR BUSINESS
LOCATION?
RESIDENTIAL BUSINESS
If a residentially installed systeD, pleasg_couplete- guestions
i-.t r."eh-el--if-ihe systern is- being-installed-9t a busiuess
r";;i;; tI"""" conpllte questions 7 through 13'
1. Name:
2. Address:
City,- state 2
-
zip:
3. Phone Number: 4' Date of Birth:-
5. Is the lystem being installed by the homeovner? Yes- No-
If no, then indicate the company that vill be installing the alarm
system:
6. Date of installation:
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7. Business name only if system vas installed in business):
8. Ovner Name:
9. 0vner date of birth:
10. Business address:
State:,ro, ?1/77Ci ty:
11. Phone N'
12. CompanY that installed alarm sYStem:
()f
13. Date of installation:
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ELEGTRIGAL PERMIT REOUIRED